Nevin Manimala

Turk Neurosurg. 2020 Nov 5. doi: 10.5137/1019-5149.JTN.31778-20.2. Online ahead of print.

ABSTRACT

AIM: This study aimed to assess the craniocervical junction (CCJ) by using radiological measurements in patients with Adolescent Idiopathic Scoliosis (AIS) and Scheuermann’s Kyphosis (SK) compared to normal adolescent population.

MATERIAL AND METHODS: Patients were assigned to three groups. Group 1 consisted of AIS patients, Group 2 consisted of patients with SK, and Group 3 was the control group who had no spinal disorder. The groups were matched based on age and gender. Major Cobb angle and kyphosis angle were measured on X-Ray. Basion-axial interval (BAI), basion-dens interval (BDI), posterior atlantodental interval (PADI), anterior atlantodental interval (ADI), atlanto-occipital interval (AOI), and Power’s ratio were measured by computer tomography. The results were compared in each group statistically.

RESULTS: A total of 120 participants, comprised of 78 (65%) female and 42 (35%) male were included in the study. There was no statistically difference between 3 groups based on age and gender (p 0.05). According to the measurements, Group 3 had significantly higher PADI measurements than Group 1 (p=0.01). The ADI measurements of Group 2 were significantly higher than those of Group 1 and Group 3 (p=0.01). Group 3 had significantly higher BDI measurements than Group 1 and Group 2. (p=0.01). The Power ratios of Group 1 and Group 3 were statistically higher than that of Group 2 (p=0.01). There were no statistically significant differences between the groups in terms of AOI and BAI measurements (p=0.84, p=0.18, respectively).

CONCLUSION: The presence of AIS and Scheuermann’s kyphosis may affect the measurement of CCJ and it may be considered to evaluate instability of the region.

PMID:33759172 | DOI:10.5137/1019-5149.JTN.31778-20.2

Turk Neurosurg. 2020 Nov 11. doi: 10.5137/1019-5149.JTN.30092-20.1. Online ahead of print.

ABSTRACT

AIM: In radiogenomics, certain MRI features have been recently associated to predict genetic alterations. We analyzed certain MRI features as well as six major genetic biomarkers, investigated their associations, and evaluated their prognostic roles in glioblastomas (GBMs).

MATERIAL AND METHODS: Strict criteria included newly diagnosed GBM with optimal treatments. Simple manual imaging characteristics (tumor side, location, enhancement, diameter, depth, radiographic necrosis, and edema) were obtained from preoperative conventional MRI. Furthermore, all the status of the MGMT promoter, Chromosome 1p and 19q, IDH, TERT, and BRAF in tumor tissues were detected.

RESULTS: Among 126 inpatients, 60 cases were selected and enrolled in the study. The status of the MGMT promoter was significantly associated with the grade of radiographic necrosis (p = 0.033). The rate of 19q deletion was significantly higher in tumors with the ring-shaped peritumoral edema (PTE) (p = 0.035) and in tumors with the ring-enhanced trait (p = 0.023). Univariate analysis showed that a low PTE index and MGMT promoter methylation were both unfavorable prognostic factors. While the PTE index statistically dropped out, the status of the MGMT promoter and the depth of the tumor were observed to be independent prognostic factors in multivariate analysis.

CONCLUSION: Based on simple neuroimaging metrics, novel connections between features of preoperative conventional MRI and status of major genetic biomarkers were observed, especially for the MGMT promoter and 19q.

PMID:33759171 | DOI:10.5137/1019-5149.JTN.30092-20.1

Turk Neurosurg. 2020 Oct 1. doi: 10.5137/1019-5149.JTN.30578-20.3. Online ahead of print.

ABSTRACT

AIM: Design a novel hand-held retractor to reduce operation time and radiation exposure in percutaneous pedicle screw placement.

MATERIAL AND METHODS: 126 patients with single segment thoracolumbar vertebral fracture were surgically treated with percutaneous pedicle screws through our novel hand-held retractor technique（group A） or conventional fluoroscopic method(group B), the operation time and fluoroscopy shot times were compared, and the accuracy of screw placement were assessed.

RESULTS: There was no serious complications occurring during our study, such as infection, blood vessel injury, spinal cord or nerve root injury. We did not find any statistically difference between the two groups in corrected rate of regional Cobb’s angle or vertebral body height percentage(P 0.05), however, the mean operation time was found to be 75.9±2.37min in the novel hand-held retractor method group and 94.2±2.19min in the conventional method group. The difference was statistically significant (p﹤0.001). Fluoroscopy shot times averaged 9.01±0.41 in the novel hand-held retractor group versus 16.8±0.56 in the conventional group (P 0.001), the novel hand-held retractor group had apparent advantages over the conventional method in postoperative improvement on visual analog scale (VAS) scores and Oswestry Disability Index (ODI) at 2days, 3month after operation and last follow-up (P 0.05). There was no statistical difference between group A and B in the radiographic results and screw position violation grade.

CONCLUSION: The novel hand-held method retractors have several advantages, including shorter operation time, less fluoroscopy shot times, and better postoperative improvement on visual analog scale (VAS) scores and Oswestry Disability Index (ODI). It provides a new alternative method for effective management of thoracolumbar fractures.

PMID:33759168 | DOI:10.5137/1019-5149.JTN.30578-20.3

Turk Neurosurg. 2020 Sep 19. doi: 10.5137/1019-5149.JTN.32026-20.1. Online ahead of print.

ABSTRACT

AIM: Hippocampal sclerosis (HS) is the most common neuropathological finding in patients undergoing surgery for drug-resistant temporal lobe epilepsy. Approximately 60-90% of patients operated for HS live without a seizure. In 2013, the International League Against Epilepsy (ILAE) reported a new classification based on specific cell losses in Hippocampal Sclerosis. We aimed to investigate the relationship between clinical features and prognosis of the HS cases and ILAE histopathology classification.

MATERIAL AND METHODS: A hundred patients with refractory epilepsy who were operated with the diagnosis of the Mesial Temporal Lobe Epilepsy were included in the study. Socio-demographic characteristics, clinical and family histories, post-operative ILAE and Engel epilepsy scores and diagnostic tests were recorded. At the same time, all of the pathological specimens were classified according to the new semi-quantitative ILAE classification. A significant statistical relationship was investigated between clinical data and HS-ILAE groups.

RESULTS: There were 36 male 64 female patients. The mean follow-up period was 6.5 years. 75% of the cases were HS-ILAE type 1, 19% HS-ILAE type 2, 6% were unidentifiable. FCD3A was detected in 3 patients. The HS-ILAE Type 2 ratio was high on the right-sided cases. In addition, HS-ILAE Type 1 ratio was high in patients with early seizure onset and long duration of epilepsy. There was no significant relationship between long-term ILAE and Engel epilepsy outcome scores and HS-ILAE types.

CONCLUSION: Resection of mesiotemporal structures in hippocampal sclerosis provides seizure control in at least two-thirds of cases. Histopathological findings may help us understand the epileptogenicity-prognosis of HS. The relationship between ILAE histopathology classification and clinical factors will become more obvious in the future. According to our study, there was a relationship between onset age of epilepsy, epilepsy duration, lesion side and HS-ILAE types. The reinforcement of these relationships with larger series will benefit clinicians.

PMID:33759167 | DOI:10.5137/1019-5149.JTN.32026-20.1

mSystems. 2021 Mar 23;6(2):e01305-20. doi: 10.1128/mSystems.01305-20.

ABSTRACT

The NCBI Gene Expression Omnibus (GEO) provides tools to query and download transcriptomic data. However, less than 4% of microbial experiments include the sample group annotations required to assess differential gene expression for high-throughput reanalysis, and data deposited after 2014 universally lack these annotations. Our algorithm GAUGE (general annotation using text/data group ensembles) automatically annotates GEO microbial data sets, including microarray and RNA sequencing studies, increasing the percentage of data sets amenable to analysis from 4% to 33%. Eighty-nine percent of GAUGE-annotated studies matched group assignments generated by human curators. To demonstrate how GAUGE annotation can lead to scientific insight, we created GAPE (GAUGE-annotated Pseudomonas aeruginosa and Escherichia coli transcriptomic compendia for reanalysis), a Shiny Web interface to analyze 73 GAUGE-annotated P. aeruginosa studies, three times more than previously available. GAPE analysis revealed that PA3923, a gene of unknown function, was frequently differentially expressed in more than 50% of studies and significantly coregulated with genes involved in biofilm formation. Follow-up wet-bench experiments demonstrate that PA3923 mutants are indeed defective in biofilm formation, consistent with predictions facilitated by GAUGE and GAPE. We anticipate that GAUGE and GAPE, which we have made freely available, will make publicly available microbial transcriptomic data easier to reuse and lead to new data-driven hypotheses.IMPORTANCE GEO archives transcriptomic data from over 5,800 microbial experiments and allows researchers to answer questions not directly addressed in published papers. However, less than 4% of the microbial data sets include the sample group annotations required for high-throughput reanalysis. This limitation blocks a considerable amount of microbial transcriptomic data from being reused easily. Here, we demonstrate that the GAUGE algorithm could make 33% of microbial data accessible to parallel mining and reanalysis. GAUGE annotations increase statistical power and, thereby, make consistent patterns of differential gene expression easier to identify. In addition, we developed GAPE (GAUGE-annotated Pseudomonas aeruginosa and Escherichia coli transcriptomic compendia for reanalysis), a Shiny Web interface that performs parallel analyses on P. aeruginosa and E. coli compendia. Source code for GAUGE and GAPE is freely available and can be repurposed to create compendia for other bacterial species.

PMID:33758032 | DOI:10.1128/mSystems.01305-20

BMJ Glob Health. 2021 Mar;6(3):e004564. doi: 10.1136/bmjgh-2020-004564.

ABSTRACT

BACKGROUND: The burden of COVID-19 in low-income and conflict-affected countries remains unclear, largely reflecting low testing rates. In parts of Yemen, reports indicated a peak in hospital admissions and burials during May-June 2020. To estimate excess mortality during the epidemic period, we quantified activity across all identifiable cemeteries within Aden governorate (population approximately 1 million) by analysing very high-resolution satellite imagery and compared estimates to Civil Registry office records.

METHODS: After identifying active cemeteries through remote and ground information, we applied geospatial analysis techniques to manually identify new grave plots and measure changes in burial surface area over a period from July 2016 to September 2020. After imputing missing grave counts using surface area data, we used alternative approaches, including simple interpolation and a generalised additive mixed growth model, to predict both actual and counterfactual (no epidemic) burial rates by cemetery and across the governorate during the most likely period of COVID-19 excess mortality (from 1 April 2020) and thereby compute excess burials. We also analysed death notifications to the Civil Registry office over the same period.

RESULTS: We collected 78 observations from 11 cemeteries. In all but one, a peak in daily burial rates was evident from April to July 2020. Interpolation and mixed model methods estimated ≈1500 excess burials up to 6 July, and 2120 up to 19 September, corresponding to a peak weekly increase of 230% from the counterfactual. Satellite imagery estimates were generally lower than Civil Registry data, which indicated a peak 1823 deaths in May alone. However, both sources suggested the epidemic had waned by September 2020.

DISCUSSION: To our knowledge, this is the first instance of satellite imagery being used for population mortality estimation. Findings suggest a substantial, under-ascertained impact of COVID-19 in this urban Yemeni governorate and are broadly in line with previous mathematical modelling predictions, though our method cannot distinguish direct from indirect virus deaths. Satellite imagery burial analysis appears a promising novel approach for monitoring epidemics and other crisis impacts, particularly where ground data are difficult to collect.

PMID:33758012 | DOI:10.1136/bmjgh-2020-004564

BMJ. 2021 Mar 23;372:n461. doi: 10.1136/bmj.n461.

ABSTRACT

OBJECTIVE: To assess age differences in risk factors for incident heart failure in the general population.

DESIGN: Pooled population based cohort study.

SETTING: Framingham Heart Study, Prevention of Renal and Vascular End-stage Disease Study, and Multi-Ethnic Study of Atherosclerosis.

PARTICIPANTS: 24 675 participants without a history of heart failure stratified by age into young (<55 years; n=11 599), middle aged (55-64 years; n=5587), old (65-74 years; n=5190), and elderly (≥75 years; n=2299) individuals.

MAIN OUTCOME MEASURE: Incident heart failure.

RESULTS: Over a median follow-up of 12.7 years, 138/11 599 (1%), 293/5587 (5%), 538/5190 (10%), and 412/2299 (18%) of young, middle aged, old, and elderly participants, respectively, developed heart failure. In young participants, 32% (n=44) of heart failure cases were classified as heart failure with preserved ejection fraction compared with 43% (n=179) in elderly participants. Risk factors including hypertension, diabetes, current smoking history, and previous myocardial infarction conferred greater relative risk in younger compared with older participants (P for interaction <0.05 for all). For example, hypertension was associated with a threefold increase in risk of future heart failure in young participants (hazard ratio 3.02, 95% confidence interval 2.10 to 4.34; P<0.001) compared with a 1.4-fold risk in elderly participants (1.43, 1.13 to 1.81; P=0.003). The absolute risk for developing heart failure was lower in younger than in older participants with and without risk factors. Importantly, known risk factors explained a greater proportion of overall population attributable risk for heart failure in young participants (75% v 53% in elderly participants), with better model performance (C index 0.79 v 0.64). Similarly, the population attributable risks of obesity (21% v 13%), hypertension (35% v 23%), diabetes (14% v 7%), and current smoking (32% v 1%) were higher in young compared with elderly participants.

CONCLUSIONS: Despite a lower incidence and absolute risk of heart failure among younger compared with older people, the stronger association and greater attributable risk of modifiable risk factors among young participants highlight the importance of preventive efforts across the adult life course.

PMID:33758001 | DOI:10.1136/bmj.n461

Br J Sports Med. 2021 Mar 23:bjsports-2020-103274. doi: 10.1136/bjsports-2020-103274. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the role of salivary small non-coding RNAs (sncRNAs) in the diagnosis of sport-related concussion.

METHODS: Saliva was obtained from male professional players in the top two tiers of England’s elite rugby union competition across two seasons (2017-2019). Samples were collected preseason from 1028 players, and during standardised head injury assessments (HIAs) at three time points (in-game, post-game, and 36-48 hours post-game) from 156 of these. Samples were also collected from controls (102 uninjured players and 66 players sustaining a musculoskeletal injury). Diagnostic sncRNAs were identified with next generation sequencing and validated using quantitative PCR in 702 samples. A predictive logistic regression model was built on 2017-2018 data (training dataset) and prospectively validated the following season (test dataset).

RESULTS: The HIA process confirmed concussion in 106 players (HIA+) and excluded this in 50 (HIA-). 32 sncRNAs were significantly differentially expressed across these two groups, with let-7f-5p showing the highest area under the curve (AUC) at 36-48 hours. Additionally, a combined panel of 14 sncRNAs (let-7a-5p, miR-143-3p, miR-103a-3p, miR-34b-3p, RNU6-7, RNU6-45, Snora57, snoU13.120, tRNA18Arg-CCT, U6-168, U6-428, U6-1249, Uco22cjg1,YRNA_255) could differentiate concussed subjects from all other groups, including players who were HIA- and controls, immediately after the game (AUC 0.91, 95% CI 0.81 to 1) and 36-48 hours later (AUC 0.94, 95% CI 0.86 to 1). When prospectively tested, the panel confirmed high predictive accuracy (AUC 0.96, 95% CI 0.92 to 1 post-game and AUC 0.93, 95% CI 0.86 to 1 at 36-48 hours).

CONCLUSIONS: SCRUM, a large prospective observational study of non-invasive concussion biomarkers, has identified unique signatures of concussion in saliva of male athletes diagnosed with concussion.

PMID:33757972 | DOI:10.1136/bjsports-2020-103274

BJGP Open. 2021 Mar 23:BJGPO.2021.0016. doi: 10.3399/BJGPO.2021.0016. Online ahead of print.

ABSTRACT

BACKGROUND: About 10-35% of people with COVID-19 merit medical care within three weeks of infection. However, the prevalence of ongoing care needs among those experiencing severe COVID-19 illness is unclear.

AIM: This pilot study aimed to address this knowledge gap by examining GP attendance trends among patients attending a post-COVID-19 hospital follow-up clinic, 3-6 months after an initial clinic visit.

DESIGN, AND SETTING: Data was collected from adult patients attending a post-COVID-19 follow-up clinic at the Mater Misericordiae University Hospital, Dublin, Ireland.

METHOD: Participants completed questionnaires outlining their demographics, medical histories, emergency hospital admissions/re-admissions where applicable, and where relevant, GP attendances following hospital discharge. Analyses were conducted using descriptive/inferential statistics.

RESULTS: Participants’ (n=153) median age =43.5 (IQR =30.9-52.1 years). There were 105 females (68.6%, 95% CI=61.3%-75.9%). Various medical histories were reported among participants. 67 (43.2%, 95% CI=35.9%-51.6%) received emergency COVID-19 hospital care. Older adults, males, ICU admissions, and re-admissions were common among hospital attendees. Of the hospital attendees, 16 (24%, 95% CI=13.7%-34.2%) and 26 (39%, 95% CI=27.3%-50.7%) attended GPs within seven and 30 days of hospital discharge. Older adults, people with pre-existing medical conditions, and individuals admitted to ICU/readmitted to hospital were common among general practice attendees.

CONCLUSION: Persistent health issues appear to be common among severe COVID-19 patients, particularly those who are older adults, have pre-existing health problems, and had been in ICU and/or re-admission care. Larger scale studies of ongoing COVID-19 care needs in general practice/primary care are required.

PMID:33757962 | DOI:10.3399/BJGPO.2021.0016

BMJ Open. 2021 Mar 23;11(3):e046138. doi: 10.1136/bmjopen-2020-046138.

ABSTRACT

INTRODUCTION: Frailty and pain are associated with adverse patient clinical outcomes and healthcare system costs. Frailty and pain can interact, such that symptoms of frailty can make pain assessment difficult and pain can exacerbate the progression of frailty. The prevalence of frailty and pain and their concurrence in hospital settings are not well understood, and patients with cognitive impairment are often excluded from pain prevalence studies due to difficulties assessing their pain. The aim of this study is to determine the prevalence of frailty and pain in adult inpatients, including those with cognitive impairment, in an acute care private metropolitan hospital in Western Australia.

METHODS AND ANALYSIS: A prospective, observational, single-day point prevalence, cross-sectional study of frailty and pain intensity of all inpatients (excluding day surgery and critical care units) will be undertaken. Frailty will be assessed using the modified Reported Edmonton Frail Scale. Current pain intensity will be assessed using the PainChek smart-device application enabling pain assessment in people unable to report pain due to cognitive impairment. Participants will also provide a numerical rating of the intensity of current pain and the worst pain experienced in the previous 24 hours. Demographic and clinical information will be collected from patient files. The overall response rate of the survey will be reported, as well as the percentage prevalence of frailty and of pain in the sample (separately for PainChek scores and numerical ratings). Additional statistical modelling will be conducted comparing frailty scores with pain scores, adjusting for covariates including age, gender, ward type and reason for admission.

ETHICS AND DISSEMINATION: Ethical approval has been granted by Ramsay Health Care Human Research Ethics Committee WA/SA (reference: 2038) and Edith Cowan University Human Research Ethics Committee (reference: 2020-02008-SAUNDERS). Findings will be widely disseminated through conference presentations, peer-reviewed publications and social media.

TRIAL REGISTRATION NUMBER: ACTRN12620000904976.

PMID:33757956 | DOI:10.1136/bmjopen-2020-046138